Senior Director, Risk Management

At Curana Health, we're on a mission to radically improve the health, happiness, and dignity of older adults—and we're looking for passionate people to help us do it.

As a national leader in value-based care, we offer senior living communities and skilled nursing facilities a wide range of solutions (including on-site primary care services, Accountable Care Organizations, and Medicare Advantage Special Needs Plans) proven to enhance health outcomes, streamline operations, and create new financial opportunities.

Founded in 2021, we've grown quickly—now serving 200,000+ seniors in 1,500+ communities across 32 states. Our team includes more than 1,000 clinicians alongside care coordinators, analysts, operators, and professionals from all backgrounds, all working together to deliver high-quality, proactive solutions for senior living operators and those they care for.

Ranked #147 on the Inc. 5000 list of America's fastest-growing private companies, we're just getting started. If you're looking to make a meaningful impact on the senior healthcare landscape, you're in the right place—and we look forward to working with you.

For more information about our company, visit CuranaHealth.com.

Summary

Reporting to the Chief Legal Officer, the Senior Director, Risk Management builds and leads the Company's risk management function, including accountability for insurance claims management, clinical risk management, and oversight of the company’s insurance portfolio and coverage strategy. The Senior Director establishes the processes, technology, governance, and measures required to support progressively higher levels of retained risk. The Senior Director is also expected to be capable with artificial intelligence tools and to assess where and how AI can be deployed to strengthen the risk management program. This is a strategic and hands-on leadership role supporting a national health care organization that includes a medical group employing approximately 350 physicians and 1,250 advanced practice providers across more than thirty states, two multi-state Medicare ACOs, and a multi-state Medicare Advantage ISNP.

The Senior Director leads the Company's claims management strategy from first notice through final resolution, including investigation, liability and damages evaluation, exposure assessment, reserve recommendations, panel counsel oversight, mediation and settlement strategy, and trial posture. The successful candidate will remain personally engaged in significant claims while building the Company's broader risk management capabilities. The Senior Director will also design and implement a robust clinical risk management program that converts claims, complaints, and adverse-event information into trend identification, education, and measurable risk reduction. A core measure of success is demonstrated improvement in total cost of risk, including retained loss outcomes, defense spend, and insurance program economics.

Essential Duties & Responsibilities

Claims Management

Serves as the Company's senior claims leader and designs a claims management function capable of supporting progressively higher levels of retained risk.

Leads the Company's strategy and active participation in complex medical professional liability claims from first notice through final resolution, including fact development, medical-record review, witness identification, and preservation of evidence.

Evaluates liability, causation, damages, venue and verdict risk, and potential exposure; develops documented strategy and resolution recommendations with the carrier and panel counsel. Supports litigated matters through discovery, witness and deposition preparation, expert selection, and trial preparation.

Develops and maintains independent per-claim reserve positions that account for the Company’s retained exposure separately from carrier reserves, including documented liability, damages, and venue analysis on each significant file. Presents material reserve movements and aggregate retained loss forecasts to the CFO on a defined cadence, and supports accrual and audit positions in coordination with Finance and the CLO.

Develops settlement recommendations and obtains internal authority; leads the Company's mediation and settlement planning and participates actively with the carrier and panel counsel in negotiations and resolution decisions, subject to policy terms and carrier authority.

Participates in selection of defense counsel from carrier-approved panels where permitted; works closely with panel counsel; evaluates performance; recommends litigation plans and budgets; and escalates concerns to the carrier and Legal department.

Designs the operating model for claims administration, including appropriate use of internal personnel, carriers, third-party administrators, consultants, and technology. Establishes claims triage, escalation, file documentation, and authority protocols aligned with carrier requirements and with practices designed with the Legal department to preserve attorney-client privilege and work-product protection.

Identifies, evaluates, and deploys artificial intelligence and analytics tools to strengthen claims work, including intake and triage, medical-record review and summarization, exposure analysis, loss-trend detection, and review of defense counsel budgets, with appropriate human review and controls for privilege and protected health information.

Oversees carrier and excess-carrier notice and reporting, loss-run reconciliation, and coverage analysis; escalates disputed coverage positions to the Legal department.

Administers consent-to-settle requirements and coordinates National Practitioner Data Bank and state licensing-board reporting with the Legal, credentialing, and clinical functions.

Manages employment and other insured claims in coordination with Human Resources, employment counsel, carriers, and other internal stakeholders.

Establishes claim review cadence and metrics addressing frequency, severity, loss development, defense spend, cycle time, resolution outcomes, and recurring causes of loss. Establishes and tracks total cost of risk metrics including retained loss ratios, defense spend as a percentage of indemnity, and year-over-year program cost movement, and presents performance against external benchmarks to the CFO and CLO on a quarterly basis.

Coordinates actuarial loss forecasting and incurred-but-not-reported analyses and partners with Finance on accrual methodology, retained-loss forecasting, collateral, and audit support.

Clinical Risk Management Program Development

Designs, builds, and leads the Company's clinical risk management program including its operating model, staffing, workflows, escalation criteria, and measures, in partnership with clinical, quality, credentialing, operational, legal, and finance leaders.

Aggregates and analyzes claims, complaint, adverse-event, and near-miss information to identify trends by specialty, care setting, site, region, clinician cohort, allegation, and contributing factor.

Applies AI and analytics to event, complaint, and claims narratives to surface contributing factors and emerging trends at a scale that manual review cannot achieve, and validates outputs before they inform clinical risk conclusions.

Defines and reports key measures, including claim frequency and severity, loss development, defense spend, total cost of risk, resolution cycle time, and education completion.

Translates trends into targeted risk-reduction initiatives and clinician and staff education, including documentation, informed consent, communication, goals-of-care discussions, and transitions of care.

Develops practical event and near-miss reporting capabilities for clinicians practicing in facilities controlled by third parties, including interfaces or parallel reporting channels.

Provides risk management consultation regarding adverse events, unanticipated outcomes, disclosure conversations, escalated compl